July 2011

On Monday, a woman named Michelle McKee was sentenced to 2 years in prison for defrauding the Colorado workers’ comp system out of $25,000. North Carolina workers’ compensation experts and analysts are closely following the story, as it may have relevance to in-state cases. According to a local news report, McKee had been working as a housekeeper at a hotel, when she hurt her ankle. Although she claimed the injury was work related, an insurance investigation found that McKee had been bragging to friends about cheating the workers’ comp system. She also allegedly admitted to hurting herself not while at work but while out partying (she twisted her ankle after stepping off a curb). The state’s senior assistant Attorney General convinced the court that Ms. McKee had made false statements to collect money – a felony charge. In addition to her 2-year jail sentence, Ms. McKee now faces $25,000 in forced restitution to her old employer, Pinnacol Assurance.

As this blog has often discussed, North Carolina workers’ compensation fraud matters create tensions throughout the system and ultimately harm all major players involved: insurance companies, employers, legislators, and genuinely injured employees. It’s this latter category that is most vulnerable – subsequent to fraud cases like this one, legitimately hurt workers will likely have a harder time in Colorado collecting benefits without hassle. When insurance companies and employers grow suspicious of claimants, they tend to require higher burdens of proof and conduct longer investigations as to the veracity of claims.

If you’ve been the victim of undue harassment, frustration, or non-compliance by your employer or your employer’s insurance company, it may behoove you to seek out the counsel of a North Carolina workers’ compensation attorney to figure out how to resolve your situation adequately, get the benefits you want, and get these issues off your mind so you can focus on recovering and fixing your financial circumstances.

Many North Carolina workers’ compensation beneficiaries (or people who want workers’ comp money) labor under a variety of painful and generally destructive delusions. Let’s dig into some of those, rip them apart, and talk about how to approach your struggles more productively.

Obviously, maximizing your compensation gives you more leverage and resources. And if you’re in pain, unable to work, and saddled with serious bills and costs to take care of your family, you want to open up your options. But the resources you have are actually in some ways less important than the resourcefulness you demonstrate.

Learning better problem-solving costs nothing but can redound to a hugely positive effect. In other words, regardless of whether you collect a lot of money or less than you thought, you can leverage that money to better effect if you think more clearly about what you want to achieve with that money. (If that makes sense.)

Delusion #2. The best you can hope for is to “make it back” to where you were before you got hurt or injured.

This delusion is an absolute killer because it de-motivates victims and makes them feel disempowered and unresourceful. In fact, many famous business leaders emerged from bankruptcy to become tycoons. So, too, can many hurt and “down and out” workers emerge to become better, healthier, wealthier, and happier than they were before they got injured. It’s all a matter of frame of reference. If yours is tilted towards the negative, change it, ASAP.

Delusion #3. You injury/illness will permanently make you “less happy.”

If you’ve recently been hurt or made sick at work, you may feel like your life has changed dramatically, for the worse. And it might have, objectively speaking. But in terms of your happiness, don’t jump to conclusions. As researcher Daniel Gilbert notes in his book, Stumbling on Happiness, our levels of happiness do not necessarily correspond with objective circumstances. You can be on top of the world – a multibillionaire – and miserable. Likewise, you can be about to be decapitated at a guillotine and feel wonderful about your life.

If you’re a worker who needs North Carolina workers’ compensation benefits to pay for a painful carpal tunnel surgery, injury rehab, or even extensive and expensive surgical bills, you’re probably only looking one or two steps down the road.

You’re probably thinking along the lines of…

• How can I maximize my benefits? • How can I prevent my employer from treating me unfairly? • How can I compel an insurance company to “play fair?” • How can I better understand my obligations under North Carolina law? Etc

These are all crucial questions to ask – and obviously a qualified North Carolina workers’ compensation law firm can help you figure them out. But deeper issues might be at play. And deeper questions may need to be asked, if you really want to recover completely from your injury or illness, get back into the workforce, and put the painful incident or accident behind you for good.

Let’s say you suffered a terrible typing injury at work. Maybe you worked as a receptionist for some bank located in the Research Triangle in Raleigh, for example. You might casually assume that the cause of your stress was all of the typing you did. And you might be right – but perhaps only partially. It might be that there are some other factors – such as dietary influences (too much sugar, vitamin deficiency of some kind, etc), postural stressors or back alignment issues, etc.

And if you fail to address those fundamental problems, you will never recover full function. And even if you do recover some function and return to work, you will likely continue to stress and hurt yourself — even if you take steps towards reducing the amount of typing you do. In other words, if the primary stimulators of pain and illness remain entrenched, then your solutions won’t work well, or they won’t work for long.

So how do you tap into these bigger and deeper solutions? First off, expand your thinking. Get multiple opinions about your injury and accident – and look at the problem from many different angles. Talk to people who have had similar problems. And experiment – obviously under the direction of your doctor – with various processes and methods and tools to treat your issues and prevent them from coming back.

Educated patients – educated workers’ comp clients – tend to recover faster and easier, even when the odds are stacked against them.

A Nevada Supreme Court ruling on July 15th has rippled across the nation and grabbed the attention of analysts and pundits in the North Carolina workers’ compensation community. The NV Supreme Court ruled that a North Las Vegas correctional officer is not entitled to collect workers’ comp benefits. It’s a relatively “run of the mill” story…at least on the surface.

First, the details.

Jacqueline Phillips hurt herself in 2005 – ostensibly because she lifted heavy boxes at her job. Her claim was denied.

In September 2007, Phillips again filed for workers’ comp, this time because she claimed that she hurt herself pulling an inmate from a squad car into a holding cell. A quote from the Las Vegas Sun article describes what happened to her: “On September 22, 2007, she said she was injured on the job while transferring the inmate. She initially told her doctor this was an aggravation of the injury suffered in 2005. She told a second physician her symptoms began on September 30, or eight days after the reported incident. The city denied her claim. She was then treated by a third doctor whom she told her symptoms began on September 22.”

The court ruled that the doctors who treated Phillips did not link the injury with the event that happened on September 22. In other words, despite Phillips’ word that she had been hurt, neither the doctors nor the courts believed her – or least believed her to the point that they allowed her to start collecting benefits.

So this case might not have been particularly noteworthy, and it’s not like the mainstream media is engaging in a feeding frenzy about it. It’s no Casey Anthony. But it does hold important lessons for potential North Carolina workers’ compensation claimants. Specifically, it suggests that your word alone may not be enough.

In other words, YOU may believe that you got hurt on the job. But it takes more than subjective opinion to win a benefits case. Unfortunately, many claimants make errors of judgment, give inaccurate statements, and wait too long to get help from legal professionals. As a result of flailing and delaying, they may further injure their chances of being able to win a claim.

An experienced North Carolina workers’ compensation law firm can help you identify: A, whether or not you have a case against an insurer, employer, or other institution and B, help you figure out a “best path,” strategically speaking, to get the compensation in the shortest, easiest way.

Congress’ investigative arm, the Government Accountability Office (GAO), wants to clamp down on North Carolina workers’ compensation fraud (and workers’ comp fraud throughout the country). According to the official GAO website, the government is seeking information about beneficiaries secretly working second jobs, overstating claims, or collecting money owed to a deceased worker.

In fiscal year 2009, the U.S. Office of Workers’ Compensation Programs paid more than a quarter of a million workers over $4.1 billion (disbursed through four programs) for workplace injuries and illnesses. Many of these workers resided in North Carolina. (To be more specific, only $2.73 billion was spent on federal workers or their survivors, per the GAO’s report.)

It’s nice to see the government trying to clamp down on North Carolina workers’ compensation fraud, since systemic abuse doesn’t just hurt “faceless” corporate entities and government agencies with big pockets. Fraud “pays forward” throughout the system and creates mistrust, frustration, gridlock, friction, and bureaucracy.

When insurers and employers become more suspicious of beneficiaries’ intentions and actions, they throw up more roadblocks to prevent getting scammed. Inevitably, legitimate claims get held up in the dragnet. What’s the most appropriate response to this kind of abuse? Should scam artists, schemers, and those who aid and abet workers’ comp fraud be punished harshly?

Perhaps a better solution would be to disincentivize fraud through some non-punitive way. A broad and deep analysis of typical workers’ comp fraud crimes, for instance, might reveal certain patterns of behavior and typical perpetrator motivations. Policy analysts could then work towards solving would-be perpetrators’ problems in advance to prevent them from turning to the dark side and seeking to exploit vulnerabilities in the system.

A new study released by the Workers’ Compensation Research Institute (WCRI) has worried many in the North Carolina workers’ compensation community. The report, Interstate Variations in Use of Narcotics, suggests that injured workers often abuse and/or misuse narcotics prescribed to treat workplace injuries. According to a WCRI press release, “In certain states…patients who begin treatment with narcotics are more likely to end up using narcotics on a longer-term bases – California, Louisiana, Massachusetts, New York, North Carolina, Pennsylvania, and Texas.” Louisiana was the worst offender – with a rate of 1 out of 6 injured workers who possibly misuse/abuse narcotics. According to the WCRI, “In a typical state, the figure is 1 out of 20.”

So let’s dig a little deeper here. Why would North Carolina workers’ compensation beneficiaries who need medication for pain fail to follow a doctor’s orders and either take more narcotics than necessary or otherwise abuse prescriptions?

This may seem like a silly and somewhat obvious question to ask. But it’s an important one. Because we need to understand the root causes if we want to figure out how to tackle the problem. A typical answer might be something in effect of “narcotics are addictive.” Or “when everything else is going wrong in your life, narcotics can help make the pain go away.”

But these answers are in many ways unsatisfying.

They suggest that hurt workers are helpless and foolish. They suggest that they don’t understand the implications of abusing or misusing narcotics. These thoughts are insulting to hurt workers. Could there be another explanation that’s somewhat more oblique but also more satisfying. According to a Harvard University psychiatrist, Dr. Lance Dodes, addictions to medications may have psychological origin – as opposed to physiological origin. Dr. Dodes points out that soldiers who fought in Vietnam became addicted to opiates while overseas – physically addicted, that is. They kicked their addictions easily after being removed from the battlefront. This suggests that psychology, as opposed to physiology, should be implicated in at least a certain kind of addiction.

Dr. Dodes proposes that addiction is in essence an empowerment response – when a hurt worker feels frustrated, angry, overwhelmed, or even just irritable about his/her situation, he/she wants to reassert control. Using or abusing medication helps the hurt worker regain a sense of control.

Dr. Dodes’ theory is deep and interesting – it runs counter to the grain of the conventional wisdom about addiction. But it’s an interesting philosophy, and if you or someone you care about has been hurt at work, and you need the help of a North Carolina workers’ compensation law firm to figure out what to do, it might also behoove you to examine Dr. Dodes’ thinking.

The political fracas that accompanied the recent debate (and subsequent passage) of North Carolina workers’ compensation reform drowned out a few curious and intriguing developments. Thanks to the reform – just penned into law by Governor Perdue – and a piece of legislation called the Patient Protection and Affordable Care Act (PPACA), states like NC (and the nation as a whole) are reassessing their medical billing systems.

North Carolina, for one, adopted new eBilling rules. The state joins Illinois, California, Minnesota, and Texas as part of a select, small group of states that has accepted the new “e-reality” of medical e-billing and moved away from traditional paper bureaucracy.

According to many experts, eBilling is inevitable. The internet is altering every facet of our lives. And more and more people feel more and more comfortable paying bills online and even banking at institutions like ING Direct.

But will eBilling eliminate redundant and needless bureaucracy and thus streamline and smooth out hiccups in the system? One would like to think so. If you Google around, you can find countless examples of how eBilling solutions have improved trade, souped up customer service, and even made whole industries workflow processes work better.

On the other hand, eBilling does carry risk. Security, technology, and recordkeeping issues abound. One can easily concoct dozens of “nightmare” scenarios, in which workers’ comp beneficiaries get sucked into a vortex of bureaucracy – or even defrauded out of money or a social security number – due to an eBilling error, technological glitch, or hacking scandal.

Nevertheless, the time has passed for what-iffing. The new eBilling paradigm is upon us.

To make sense of your rights, opportunities, and “best practices,” avoid doing all of the legwork yourself, and turn to a trusted and experienced North Carolina workers’ compensation law firm to help you develop a strategy for the way forward.

On June 25, North Carolina Governor Beverly Perdue signed an historic North Carolina workers’ compensation reform into law…and simultaneously vetoed a Republican proposed cap on medical malpractice awards.

Governor Perdue, a Democrat, called the North Carolina workers’ compensation reforms fair and balanced – she argued that the changes both protected businesses and preserved the rights of injured and sick workers. But she was far less effusive about the proposed cap on punitive damages to be awarded in medical malpractice cases. Republicans wanted the limit to be capped at $500,000. Governor Perdue responded in a written statement: “I commend the legislature for addressing this important issue [medical malpractice reform] but, in its current form, the bill is unbalanced… I urge our legislators to modify the bill when the General Assembly returns in July to protect those who are catastrophically injured.”

The North Carolina Senate passed the “medmal cap” bill by an enormous margin, but the House only passed it by a narrow, non-veto-proof margin of 62 to 44. Advocates of the cap were livid. They did not mince the words. A Republican from Rockingham, Phil Berger, the NC Senate’s leader, said Perdue’s actions dealt “a severe blow to the state’s medical community and every citizen struggling to cope with skyrocketing cost of health care.”

Over 30 states currently have some cap on medical liability damages. It’s pretty clear from interest group statements that this battle over a potential cap is far from over.

On the other hand, the changes in the workers’ comp laws have created a not insignificant amount of confusion and agita among claimants and their families. If you or someone you care about has questions about how the reforms might affect you – or needs help with a benefits question – talk to a qualified North Carolina workers’ compensation law firm about your rights and possible remedies.